Berk LB - In a study to assess the role of radiation therapy as primary and adjuvant therapy for localized or locally advanced melanoma, it was found that adjuvant nodal irradiation appears to be effective for prevention of nodal recurrence. Radiation therapy can also be effective for treatment of local disease if surgery is not an option Methods
To develop evidence-based guidelines, PubMed was searched using keywords melanoma AND radiation OR radiotherapy
References were reviewed and relevant articles selected
Articles were then reviewed for further references
Because of the paucity of prospective or randomized trials, no attempt was made to classify the quality of the results
Results
No phase III trials of nodal irradiation for prevention of regional recurrence are available
A phase III trial is being completed by the Tasman Radiation Oncology Group
A phase II trial has been completed by the group; multiple retrospective series have been published
Available data appear to confirm that nodal radiation therapy is effective in preventing nodal recurrence
No dose response or fraction size response was found
According to generally accepted guidelines, radiation therapy should be offered for patients who have nodes greater than 3 cm, more than 3 involved nodes, or extracapsular extension
For radiation therapy for treatment of metastatic disease, a phase III trial showed that 50 Gy in 2.5-Gy fractions was as effective as32 Gy in 8-Gy fractions, with 25% complete remission and 35% partial remission
Retrospective studies support that larger fraction sizes, at least 4 Gy, are more effective
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